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Summer Day Camp Financial Assistance Application 2024

Summer Day Camp Financial Assistance Application 2024

Please Note: You only have to submit ONE financial assistance form. You will have the option to add multiple children to this form.

Our program serves those individuals that are unable, but not unwilling to pay the full fee to become a member of the YMCA. We will make every effort to accommodate and determine a financial agreement that is acceptable to both you and the YMCA of Cape Breton. All information provided will be kept confidential.

Parent/Guardian Name *

First

Last

Layout

Phone *

Parent/Guardian Date of Birth *

Phone

Email *

Layout

Child's Name *

First

Last

Date of Birth

Add another child? *

Layout

Child's Name *

First

Last

Date of Birth

Add another child? *

Layout

Child's Name *

First

Last

Date of Birth

Add another child? *

Layout

Child's Name *

First

Last

Date of Birth

Add another child? *

Layout

Child's Name *

First

Last

Date of Birth

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Do you have your Previous Year Notice of Assessment/Tax Return or Three consecutive Paystubs? *

*Note only applications that have provided the required information will be processed

Notice of Assessment/Tax Return or Three Pay Stubs*(required)

Click or drag files to this area to upload. You can upload up to 99 files.

*Please attach proof of income for each adult over 18 years of age.

What is your gross annual HOUSEHOLD income*?

0-$35,127
$35,127-$43,168
$43,168-$52,433
$52,433-$59,469
$59,469-$67,072
$67,072-$74,675

*Gross annual income is the total amount of income before taxes, in a year. Check the box of the number closest to your income.

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